Effectiveness of Antimicrobial Therapy in Cardiosurgical Patients with Infectious Endocarditis Against the Background of COVID-19

There is strong evidence in the literature on the effect of multiple antimicrobial resistances on the course of the disease. There is also evidence that coronavirus disease 2019 affects the development of antibiotic resistance. The aim. To evaluate the course and outcome of the postoperative period in patients with infectious endocarditis against the background of coronavirus disease 2019, depending on the indicators of antibiotics. Materials and methods. A retrospective analysis of the case histories of 10 patients (men, aged 47 to 70 years) with infective endocarditis, who were treated at the Federal State Budgetary Institution Federal Center for Cardiovascular Surgery (Astrakhan) from 2020 to 2023, was carried out. Patients in the presence of coronavirus disease 2019 were divided into 2 groups: group 1 (n = 5) – patients with infectious endocarditis and coronavirus disease 2019; group 2 (n = 5) - patients with infectious endocarditis without coronavirus disease 2019. Diagnosis of infective endocarditis upon admission to the hospital and assessment of antimicrobial therapy was carried out using microbiological studies in accordance with the requirements of the legislation of the Russian Federation. Patients in the groups were comparable in gender, age and severity of cardiovascular pathology. The results. In patients of the 1st group, antimicrobial resistance at admission to the hospital averaged 97.33 %, in patients of the 2^nd – 40.81 %, which is 56.52 % lower than in the 1st group. This indicated the role of coronavirus disease 2019 in the development of resistance in patients with infectious endocarditis. Group 1 with multiple and choice drug resistance had an unfavorable outcome. The performed study revealed multiple antibiotic resistance of bacterial hemoculture in patients with infectious endocarditis and coronavirus disease 2019 associated with a severe course, which gives reason to consider it a risk factor for an unfavorable outcome of the disease. Since the treatment of patients with multiple resistance is problematic, it is possible to recommend the results of the analysis of accumulated observations to improve the existing clinical recommendations for the treatment of infectious endocarditis in patients with coronavirus disease 2019.

1. Abubakar U., Al-Anazi Z., Alanazi Z., Rodriguez-Baño J. Impact of COVID-19 pandemic on multidrug resistant gram positive and gram negative pathogens: A systematic review. Journal of Infection and Public Health. 2023; 16 (3): 320–331. doi: 10.106/j.jiph. 2022.12.022.

2. Abdel-Hamid R. M., Bayoumi A., Abdellateif M. S., Nooh H. A., Refaat L., Kandeel E. Z., Hasszn S. S. Bacterial co-infections in cancer patients with COVID-19: predictors and antimicrobial trends. Journal of Infection in Developing Countries. 2024; 18 (8): 1185–1195. doi: 10.3855/jidc.19731.

3. Catalano A., Lacopetta D., Ceramella J., Pellegrino M., Giuzio F., Marra M., Rosano C., Saturnino C., Sinicropi M. S., Aquaro S. Antibiotic-resistant ESKAPE pathogens and COVID-19: The Pandemic beyond the pandemic. Viruses. 2023; 15 (9): 1843. doi: 10.3390/v15091843.

4. Knight G. M., Glover R. E., McQuaid C. F., Olaru I. D., Gallandat K., Leclerc Q. J., Fuller N. M., Willcocks S. J., Hasan R., van Kleef E., Chandler C. I. Antimicrobial resistance and COVID-19: intersections and implications. Elife. 2021; 10: e64139. doi: 10.7554/elife.64139.

5. Lai C. C., Chen S. Y., Ko W. C., Hsueh P. R. Increased antimicrobial resistance during the COVID-19 pandemic. International Journal of Antimicrobial Agents. 2021; 57 (4): 106324. doi: 10.1016/j.ijantimicag.2021.106324.

6. Micheli G., Sangiorgi F., Catania F., Chiuchiarelli M., Frondizi F., Taddei E., Murri R. The Hidden Cost of COVID-19: Focus on antimicrobial resistance in bloodstream infection. Microorganisms. 2023; 11 (5): 1299. doi: 10.3390/microorganisms11051299.

7. O´Toole R. F. The interface between Covid-19 and bacterial healthcare-associated infections. Clinical Microbiology and Infection. 2021; 27 (12): 1772–1776. doi: 10.1016/j.cmi. 2021.06.001.

8. Segala F. V., Bavalo D. F., Di Gennaro F., Salvati F., Marotta C., Saracino A., Murri R., Fantoni M. Impact of Sars-CoV-2 epidemic on antimicrobial resistance: A literature review. Viruses. 2021; 13 (11); 2120. doi: 10.3390/v13112110.

9. Tseng Y. W., Huang C. W., Chen C. C., Er T. K. Assessment of antibiotic resistance patter in Central Taiwan during the Covid-19 pandemic: A retrospective study. Journal of Infection and Public Health. 2024; 17 (2); 229–235. doi: 10.1016/ j.jiph.2023.11.026.

10. Walia K., Mendelson M., Kang G., Venkatasubramanian R., Sinha R., Vijay S., Veeraraghavan B., Basnyat B., Rodrigues C., Bansal N., Ray P., Mathur P., Gopalakrishnan R., OHri V. C. How can lessons from the COVID-19 pandemic enhance antimicrobial resistance surveillance and stewardship? Lancet Infectious Diseases. 2023; 23 (8): e301–e309. doi: 10.1016/S1473-3099(23)00124-X.

11. Li Y., Ji D., Cai W., Hu Y., Bai Y., Wu J., Xu J. Clinical characteristics, cause analysis and infectivity of COVID-19 nucleic acid repositive patients: A literature review. Journal of Medical Virology. 2021; 93 (3): 1288–1295. doi: 10.1002/jmv.26491.

12. Ao Z., Li Y., Wei J., Jiang J., Wang X., Zhang P., Liu Y., Yu H., Zhu L., Wang X., Hu Q., Duan J., Hu W., Zhang X., Wu G., Guo S. Clinical characteristics and potential factors for recurrence of positive SARS-CoV-2 RNA in convalescent patients: a retrospective cohort study. Clinical and Experimental Medicine. 2021; 21 (3): 361–367. doi: 10.1007/s10238-021-00687-y.

13. Wang Z., Feng Z., Tang S., Zeng J., Ning H., Huang C., Zhang L. Resurgence of Positive qRT-PCR Test Results in Patients Recovered from COVID-19: Case Reports. American Journal of The Medical Sciences. 2021; 361 (5); 650–654. doi: 10.1016/j.amjms.2021.01.019.

14. Petrova О. V., Tverdokhlebova D. K., Shashin S. A., Nikulina D. M., Kolesnikov V. N. Microorganisms and peculiarities of the course of the postoperative period in patients with infective endocarditis and COVID-19. Astrakhanskiy meditsinskiy zhurnal = Astrakhan Medical Journal. 2024; 19 (4): 85–91. doi: 10.17021/1992-6499-2024-4-85-91.

15. Tverdokhlebova D. K., Petrova O. V., Litvinova I. N., Smel’tsova E. V., Kurashenko O. O. Longterm persistence of SARS-CoV-2 in a patient with infectious endocarditis and COVID-19: a clinical case. Prikaspiyskiy vestnik meditsiny i farmatsii = Caspian Bulletin of Medicine and Pharmacy. 2024; 5 (3): 28–33. doi: 10.17021/2712-8164-2024-3-28-33.

16. Tang X., Musa S. S., Zhao S., He D. Reinfection or Reactivation of Severe Acute Respiratory Syndrome Coronavirus 2: A Systematic Review. Frontiers in Public Health. 2021; 9: 663045. doi: 10.3389/fpubh.2021.663045.

17. Sanitary and Epidemiological Requirements for the Prevention of Infectious Diseases SanPiN 3.3686-21; approved by Decree of the Government of the Russian Federation of January 28, 2021, No. 4. URL: http://www.rospotrebnadzor.ni/files/news/SP_infections_compressed.pdf.

18. Danilov A. I., Kozlov R. S., Kozlov S. N., Evseev A. V. Practice microbiological diagnosis of infective endocarditis in the Federation. Vestnik of the Smolensk State Medical Academy = Vestnik Smolenskoy Gosudarstvennoy Medicinskoy Academy. 2019; 18 (1): 90–94.

19. Danilov A. I., Kozlov R. S., Evseev A. V. Updated recommendations of the European society of cardiolocy for the management of patients infective endocarditis. Vestnik of the Smolensk State Medical Academy = Vestnik Smolenskoy Gosudarstvennoy Medicinskoy Academy. 2017; 16 (1): 63–69.

20. Karoli N. A., Rebrov A. P. The Frequency and the character of bacterial infection in patients with COVID19. South Russian Journal of Therapeutic Practice. 2023; 4 (1): 28–39. doi: 10.21886/2712-8156-2023-4-1-28-39.

21. Chang F. Y., Chen H. C., Chen P. J., Ho M. S., Hsieh S. L., Lin J. C., Sytwu H. K. Immunologic aspects of characteristics, diagnosis, and treatment of coronavirus 2019 (COVID-19). Journal of Biomedical Science. 2020; 27 (1): doi: 10.1186/s12929-020-00663-w.